台灣醫院產業的市場結構與發展趨勢分析

An Analysis of the Market Structure and Development of Taiwan's Hospital Industry

10.6277/ter.2003.311.5

盧瑞芬(Jui-Fen Rachel Lu)；謝啟瑞(Chee-Ruey Hsieh)

醫院產業 ； 市場結構 ； 市場行為 ； 市場表現 ； 市場競爭 ； hospital industry ； market structure ； market conduct ； market performance ； market competition

經濟論文叢刊

31卷1期（2003 / 03 / 01）

107 - 153

繁體中文

醫院產業的產值在1998年約為2,804億元，佔國內生產毛額的3.14%。同時，全民健保每年近3,000億的醫療支出中，醫院部門即超過三分之二，由此可知醫院產業在醫療服務市場之重要性。本文的主要目的，即是應用產業組織領域的分析架構，從市場結構、市場行為與市場表現三個面向，探討台灣醫院產業的發展趨勢。總結本文的分析顯示，支付制度對醫院市場的競爭本質，有密切的影響。而目前醫院產業與其他產業相比，最大的差異是醫院之間的競爭型態，主要以非價格為基礎。而未來研究醫院市場的重點，將以評估各項支付制度變革對醫院產業之影響為主。

Expenditures in the hospital sector totaled approximately NT$280.4 billion in 1998, representing 3.14% of GDP and nearly two thirds of the National Health Expenditures. These figures attest to the importance of the hospital industry in the overall health care market. In this paper, we use the structure-behavior-performance paradigm of industrial organization analysis to shed light on the trends in development of Taiwan's hospital industry. We conclude that the type of payment system adopted by the government exerts considerable influence on the market structure and nature of competition among hospitals. As opposed to other industries, the most distinct feature of the current hospital industry in Taiwan is that hospitals compete primarily on a nonprice basis. An important area of future research will therefore be to assess the economic impact resulting from the various proposed reforms in Taiwan's payment system.

1. Newhouse, J. P.(2001).Medical care price indices: Problems and opportunities.經濟論文 Academia Economic Papers,29
   連結：
2. 陳端容 Chen, Duan-Rung(2002)。台灣醫療產業的組織合作：不對等合作關係運作機制之探討 Health Service Inter-organizational Cooperation in Taiwan: A Study of the Mechanisms of Asymmetric Cooperation。台灣社會學 Taiwanese Sociology，3
   連結：
3. 蔡偉德 Tsai, Wei-Der、 李一鑫 Li, I-Hsin(2002)。醫院非價格性競爭與市場結構：醫院購置高科技醫療儀器之實證研究 Hospital Nonprice Competition and Market Structure: An Empirical Study of Hospitals' Acquisition of High-tech Medical Equipment。經濟論文 Academia Economic Papers，30(1)
   連結：
4. 盧瑞芬 Lu, Rachel Jui-Fen、 蕭慶倫 Hsiao, William C.(2001)。台灣國民醫療衛生保健帳戶的建立 The Development of Taiwan's National Health Accounts。經濟論文叢刊 Taiwan Economic Review，29(4)
   連結：
5. Allen, R.(1992).Policy implications of recent hospital competition studies.Journal of Health Economics,11
6. Arrow, K. J.(1963).Uncertainty and the Welfare Economics of Medical Care.American Economic Review,53(5)
7. Bays, C. W.(1983).Why most private hospital are nonprofit.Journal of Policy Analysis and Management,2
8. Becker, E. R., Sloan, F. A.(1985).Hospital Ownership and Performance.Economic Inquiry,23
9. Cutler, D. M.(2000).The Changing Hospital Industry: Comparing Not-for-Profit and for-Profit Institution.Chicago:The University of Chicago Press.
10. Cutler, D. M., Horwitz, J. R.(2000).The Changing Hospital Industry: Comparing Not-for-Profit and for-Profit Institution.Chicago:The University of Chicago Press.
11. Cutler, D. M., Zeckhauser, R. J.(2000).Handbook of Health Economics, 1A.North Holland:Elsevier Science.
12. Dranove, D., Cone, K.(1985).Do state rate setting regulations really lower hospital expense?.Journal of Health Economics,4(2)
13. Dranove, D., Satterthwaite, M. A.(2000).Handbook of Health Economics, 1B.North Holland:Elsevier Science.
14. Dranove, D., Shanley, M., White, W. D.(1993).Price and Concentration in Hospital Markets: the Switch from Patient-Driven to Payer-Driven Competition.Journal of Law and Economics,36
15. Duggan, M. G.(2000).Hospital ownership and public medical spending.Quarterly Journal of Economics,115(4)
16. Folland, S., Goodman, A. C., Stano, M.(1997).The Economics of Health and Health Care.Upper Saddle River, NJ:Printice-Hall Inc..
17. Frech, III H. E.(1976).The Property Rights Theory of the Firm: Empirical Results from A Natural Experiment.Journal of Political Economy,84
18. Gaynor, M., Gertler, P. J.(1995).Moral hazard and risk spreading in medical partnerships.Rand Journal of Economics,26
19. Gaynor, M., Haas-Wilson, D.(1999).Change, consolidation, and competition in health care markets.Journal of Economic Perspectives,13(1)
20. Gaynor, M., Vogt, W. B.(2000).Handbook of Health Economics, 1B.North Holland:Elsevier Science.
21. Gertler, P.(1998).On the road to social health insurance: The Asian experience.World Development,26(4)
22. Hart, O., Shleifer, A., Vishny, R. W.(1997).The proper scope of government: Theory and an application to prisons.Quarterly Journal of Economics,112(4)
23. Hodgkin, D., Mcguire, T. G.(1994).Payment levels and hospital response to prospective payment.Journal of Health Economics,13
24. Hoerger, T. J.(1991).Profit variability in for-profit and not-for-profit hospital.Journal of Health Economics,10
25. Keeler, E. B., Melnick, G., Zwanziger, J.(1999).The changing effects of competition on non-profit and for-profit hospital pricing behavior.Journal of Health Economics,18
26. Keeler, E. B., Rubinstein, L. V., Kahn, K. L.(1992).Hospital characteristics and quality of care.Journal of the American Medical Association,268(13)
27. Kessler, D. P., McClellan, M. B.(2000).Is hospital competition socially wasteful?.Quarterly Journal of Economics,115(2)
28. Lane, P. M., Lindquist, J. D.(1998).Hospital choice: A summary of the key empirical and hypothetical findings of the 1980s.Journal of Health Care Marketing,8
29. Lynk, W. J.(1995).Nonprofit hospital mergers and the exercise of market power.Journal of Law and Economics,38
30. Mcguire, T. G.(2000).Handbook of Health Economics, 1A.North Holland:Elsevier Science.
31. Melnick, G., Zwanziger, J., Bamezai, A., Pattison, R.(1992).The effects of market structure and bargaining position on hospital prices.Journal of Health Economics,11
32. Newhouse, J. P.(1992).Medical Care Costs: How Much Welfare Loss?.Journal of Economic Perspectives,6(3)
33. Noether, M.(1988).Competition among Hospitals.Journal of Health Economics,7(3)
34. Pauly, M. V.(2000).Handbook of Health Economics, 1A.North Holland:Elsevier Science.
35. Pauly, M. V., Redisch, M.(1973).The not-for-profit hospital as a physician's cooperative.American Economic Review,63
36. Phelps, C. E.(1997).Health Economics.New York, NY:Addison-Wesley Educational Publishers Inc..
37. Robinson, J. C., Luft, H. S.(1985).The Impact of Hospital Market Structure on Patient Volume, Average Length of Stay, and the Cost of Care.Journal of Health Economics,4(4)
38. Salkever, D. S.(2000).Handbook of Health Economics, 1B.North Holland:Elsevier Science.
39. Salkever, D. S., Bice, T. W.(1976).The impact of certificate of need controls on hospital investment.Milbank Memorial Fund Quarterly: Health and Society,54(2)
40. Santerre, R. E., Neun, S. P.(1996).Health Economics: Theories, Insights, and Industry Studies.Chicago:Irwin.
41. Shortell, S., Hughes, E. F. X.(1988).The effect of regulation, competition, and ownership on motality rates among hospital inpatients.New England Journal of Medicine,318(7)
42. Sloan, F. A.(2000).Handbook of Health Economics, 1B.North Holland:Elsevier Science.
43. Sloan, F. A.(1981).Regulation and the rising cost of hospital care.The Review of Economics and Statistics,63(4)
44. Sloan, F. A., Steinwald, B.(1980).Effects of regulations on hospital costs and input use.Journal of Law and Economics,23
45. 中央健康保險局(2001)。全民健康保險統計。台北:中央健康保險局。
46. 江東亮 Chiang, Tung-Liang(1999)。醫療保健政策：台灣經驗。台北:巨流圖書公司。
47. 行政院主計處(1992)。中華民國行業標準分類及職業標準分類系統。台北:行政院主計處。
48. 行政院衛生署(2000)。醫療機構及醫事人員發布醫學新知或研究報告倫理守則。
49. 行政院衛生署(1999)。衛生統計（一）：公務統計。台北:行政院衛生署。
50. 李文福 Lee, Wen-Fu、 王媛慧 Wang, Yuan-Hwey(1998)。臺灣地區公私立醫學中心與區域醫院生產力變動之研究－無母數Malmquist指數之應用 Productivity Growth of Public and Private Medical Centers and Regional Hospitals in Taiwan: Nonparametric Malmquist Index。經濟論文 Academia Economic Papers，26(3)
51. 李騰嶽 、 李汝和 、 莊金德 、 張炳楠(1972)。台灣省通志：政事志衛生篇（卷三）。台中:台灣省文獻委員會。
52. 洪維河 Hong, Wei-Her、 鄭守夏 Cheng, Shou-Hsia、 張睿詒 Chang, Ray-E、 江東亮 Chiang, Tung-Liang(1998)。台灣醫療區跨區住院比例之變遷，1985-1995 Changes in the Proportion of Cross-Region Admissions in Taiwan, 1985-1995。中華公共衛生雜誌 Chinese Journal of Public Health，17(5)
53. 張樂心 、 鄭守夏 Cheng, Shou-Hsia、 楊銘欽 Yang, Ming-Chin(2002)。醫院屬性，自付價格與成本轉移。醫院產業學術研討會
54. 莊逸洲 、 黃崇哲 Huang, Chung-Che(2000)。醫療衛生機構管理制度。台北:華杏。
55. 劉容華 Liu, Jung-Hua、 江東亮 Chiang, Tung-Liang(2001)。台灣小型醫院新設與歇業之影響 Factors Affecting Opening and Closure of Small Hospitals in Taiwan。臺灣公共衛生雜誌 Taiwan Journal of Public Health，20(1)
56. 蕭慶倫 Hsiao, William C., 楊志良 Yaung, Chih-Liang, 盧瑞芬 Lu, Rachel Jui-Fen(1990).Health-care financing and delivery in the ROC: Current conditions and future challenges.自由中國之工業 Industry of Free China,73(5)
57. 謝振榮(1989)。中國文化大學日本研究所。
58. 謝琇蓮 、 江東亮 Chiang, Tung-Liang(1994)。台灣地區醫院歇業及新設之決定因素。中華公共衛生雜誌 Chinese Journal of Public Health，13(6)
59. 羅紀琼 Lo, Joan Chi-Chiung、 石淦生 Shih, Kan-Shan、 陳國樑 Chen, Kuo-Liang(1996)。醫院效率之衡量：DEA方法之應用 Technical Efficiency of the General Hospitals in Taiwan - An Application of DEA。經濟論文 Academia Economic Papers，24(3)

1. 王思云(2016)。醫療財團法人操縱有效稅率之研究。中原大學會計學系學位論文。2016。1-34。